Crossing the line of Caring

[VintageGAdog]

I was in clinical the other day and my patient had a spinal cord injury asked for a sip of water before my nurse and I left the room. The nurse said "No, Speach Therapy can do it in a few minutes when they get here." After we left her room, I innocently asked what the medical reason was for not giving her the water and why we needed to wait for Speach Therapy. The nurse said "There wasn't a medical reason. We already washed our hands." I was shocked, but didn't know how to respond. The patient did not have a MRSA or any other communicable disease. What should I do the next time this happens??? Any advise on how to help the patient without stepping on the nurses toes. I want to always cross the line of caring, even if my hands are clean.

Thank you

[ShayRN]

Sounds to me like she is just ignorant, lazy or both. I would NEVER walk out on a patient asking for some water. She deserves at the very least to be written up.:angryfire

[Q.]

The nurse's answer shocked me and her rationale is even more bizarre. Can she not wash her hands again? I don't understand. I feel absolutely horrible for the patient.

Unfortunately my only advice is to step on the nurses' toes and get the patient some water.

[SmilingBluEyes]

I so agree with "Q".

[SFCardiacRN]

Her answer was idiotic but watch yourself when second guessing an RN's care. Speech therapy + spinal cord injury is a warning signal to me of possible dysphagia. Last thing you want to do is cause an aspiration. I do think a mouth swab would be in order.

[JentheRN05, RN]

How recent was the spinal cord injury? I think the nurse was being idiotic myself. At LEAST no matter what the patient could've been given a mouth swab! I would never just leave a simple thing as a drink of water to speech therapy, unless directly instructed to do so by speech therapy (possible swallow test?) other than that NO way would I make a patient suffer because I 'just washed my hands!' I wash my hands hundreds of times a day, whats one more!!!

[VintageGAdog]

THank you for your comments. It really helps to hear what you have to say. :) I'd love to hear from more nurses out there. Anyone else have a similar experience they would like to share?

[StNeotser, ASN, RN]

I could understand it if ST needed to evaluate, and the person had a swallowing problem. But not "We've just washed our hands"

Luckily, sometimes in our clinicals we are shown What Not To Do as well.

[Tweety, BSN, RN]

My first gut reaction was the poor fellow just wanted a drink and how awful to not be able to help yourself.

Maybe, just maybe this patient has a history of manipulation and the nurse was setting limits. I recently was frustrated by a patient who did this to me. Every time I washed my hands and walked out of the room, he called me back for something else. (He was in MRSA isolation.). Finally I had to set limits, and if anyone saw me setting limits without knowing the full story, I would have been seen as lazy and mean. Yes, the poor guy was lonely and really just wanted a presence, but I needed to set limits on that.

If this were the case, she would have told you.

[onconurseRT]

:angryfire

OK--- Now.. the patient did ask for water and there was no medical reason why a sip could not have been given to the patient, right? I would have marched my little tail end back in the room and provided the basic need and given the patient the dignity that she deserves. Even if that nurse was 'Florence' in the flesh, there is no excuse for that type of behavior. BTW- Experienced nurse DOES not automatically mean GOOD nurse! After shift, I would have explained to that nurse exactly how I felt a couple years back when I was confined to a bed, urinated on myself, needed a new sanitary napkin badly and then sat in vomit for a while. Nursing is about advocating for people and giving them the best sense of dignity. I have sat in that bed and I have felt what it is like! Any nurse that works around me that decided to treat someone like that will get a lesson in humanity from me. BUT - -that is me!

[VintageGAdog]

Male Nurse Tweety,

Why do you have to set limits on how much you will care for a patient? I am still very new at this, so please don't take this the wrong way. Why does a nurse need to set limits on caring for a patient? You said your patient needed a presence and my patient needed water. How much more does it take to sit with the patient for a few minutes or rewash your hands? It seems to me that part of true patient care is also social and emotional care. I really want to understand, and maybe it will just take working daily as a nurse to understand, but I hope that I will always have time to stop and sit with a patient for a few minutes and wash my hands again.

Respectfully Carol Student Nurse

[NurseyBaby'05, BSN, RN]

I'm on a Neuro/Trauma floor and we get many spinal injury patients. I may get flamed for stereotyping/pigeonholing, but here goes: these particular patients can suck up your entire day with "just one more thing." They are very scared and feel very helpless. Understandably so. I can't even begin to imagine. Part of caring for a patient includes setting limits. This encourages patients to use their self-control and judgment. If speech is on the way shortly, it's not a crisis for the patient to wait a few minutes. Remember, this pt was probably not the only one in the nurse's assignment. You don't always have a few extra minutes everytime you are in the room, nor can you stay with the patient all day. It's just not possible. Now the reason the nurse gave the student was silly. If that is the case than she should have given the pt water. Maye she didn't want a precedent for the pt. snagging her as she was going out the door every time. If that was the case she should have said so to the student. It's important for students to learn to set limits too. I would have given it 15-20 minutes and then gone back if speech had not been to see the patient yet.